From the Guidelines
The rate of temperature change is a significant factor in the probability of seizures in pediatric patients, with rapid temperature increases being more likely to trigger febrile seizures than the absolute height of the fever itself. This is because the brain may not have sufficient time to adapt to rapid changes in temperature, potentially triggering abnormal electrical activity that results in a seizure 1. When a child's temperature rises quickly, the risk of febrile seizures increases, which is why these seizures often occur early in an illness when the temperature is rising rapidly rather than at the peak of the fever.
Key points to consider in managing fever in pediatric patients to reduce the risk of seizures include:
- Gradual fever reduction using appropriate doses of antipyretics like acetaminophen (10-15 mg/kg every 4-6 hours, maximum 5 doses in 24 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) 1.
- Avoiding aggressive cooling measures, as they can cause shivering, which may actually increase core temperature and cause discomfort.
- Recognizing that while febrile seizures can be frightening, they are generally benign and don't cause long-term neurological damage in most children, as evidenced by studies showing no significant difference in learning or neurocognitive development between children who experienced febrile seizures and those who did not 1.
It's crucial for parents and caregivers to understand that the goal is not to eliminate fever entirely but to reduce the discomfort associated with it and prevent rapid temperature increases that could trigger a seizure. By focusing on gradual fever reduction and avoiding harmful cooling methods, the risk of febrile seizures can be minimized, prioritizing the child's safety and well-being.
From the Research
Rate of Temperature Change and Seizure Probability
- The relationship between the rate of temperature change and the probability of seizures in pediatric patients is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that the height of the fever, rather than the rate of temperature change, is a significant factor in the occurrence of febrile seizures 3, 4, 6.
- For example, a study found that fever was significantly higher during episodes with seizure than in those without seizure, with a mean temperature of 39.7°C vs 38.9°C 4.
- Another study noted that the risk of febrile seizure recurrence is higher in children with a history of febrile seizures, but the rate of temperature change is not mentioned as a contributing factor 5, 6.
Antipyretic Agents and Seizure Prevention
- The use of antipyretic agents, such as ibuprofen and acetaminophen, has been studied in the context of febrile seizure prevention 2, 3, 4, 5.
- However, the evidence suggests that these agents are not effective in preventing febrile seizure recurrences 4, 5.
- A systematic review found that intermittent diazepam and continuous phenobarbitone may reduce the risk of febrile seizure recurrence, but the quality of the evidence is generally low 5.
Clinical Implications
- The provided studies emphasize the importance of evaluating children with febrile seizures to exclude underlying conditions, such as pyogenic meningitis 6.
- The long-term prognosis for children with febrile seizures is generally excellent, and antiepileptic medication is not recommended to prevent recurrence 5, 6.
- Oral diazepam or clobazam, given only when fever is present, may be an effective means of reducing the risk of recurrence 5, 6.